The Western journal of medicine
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We analyzed the medical malpractice claims data of 1,903 physicians between 1981 and 1990 to assess the efficacy--a reduced incidence of future claims and decreased payout in the event of a claim--of risk-management education for office-based physicians. Physicians were participants in the Oregon Medical Association's medical liability program and represented all recognized specialties and all geographic areas of the state. Each physician's claim and payout history before and after 4 sequential risk-management education programs was entered into a random-effects probit model that allowed for a longitudinal rather than a cross-sectional analysis. ⋯ Among all physicians, having a previous claim substantially increased the risk for a future claim. Risk for an additional claim doubled (from 7% to 14%) for physicians who had a claim in the previous year. Of all specialists who have had claims, anesthesiologists (reduction in claims incidence from 18.8% to 9.1% and in payout from 14.6% to 5%) and obstetrician-gynecologists (reduction in claims incidence from 23.3% to 15.2% and in payout from 11.6% to 4.2%) benefit most from cumulative risk-management education.
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In this article, I address ethical concerns related to forgoing futile medical treatment in terminally ill and dying patients. Any discussion of medical futility should emphasize that health professionals and health care institutions have ethical responsibilities regarding medical futility. Among the topics I address are communicating with patients and families, resolving possible conflicts, and developing professional standards. Finally, I explore why acknowledging the futility of life-prolonging medical interventions can be so difficult for patients, families, and health professionals.